N.C. ranks 35th nationwide in health care quality

North Carolinians are healthier than their neighbors in South Carolina, but not as healthy as the residents of 33 other states and the District of Columbia.

That’s the verdict of a nationwide state health care ranking issued Wednesday by The Commonwealth Fund, a New York foundation that promotes effective health care practices.

The state is improving, however. The 35th place ranking for 2015, the year covered in the report, is slightly better than its 2013 ranking of 36. South Carolina ranked 41 in 2015.

The report credits North Carolina’s improvement to the state’s Affordable Care Act enrollment, which is among the highest in the country, along with improvements in Medicare services and other measures.

The Commonwealth Fund found that all states improved in health care measures since 2013 as the rates of the uninsured have fallen, and states that expanded Medicaid saw greater gains in their rankings than states like North Carolina that did not expand the federal health insurance program for the poor. The foundation’s officials said their study underscores the perils of revoking the ACA.

“Of course the repeal and replacement of the Affordable Care Act jeopardizes many of the gains the states have made,” said Commonwealth Fund president David Blumenthal. “That puts the onus on people who want to change the current law to be sure their proposals maintain or accelerate that progress.”

The Commonwealth Fund’s report comes as Republicans in Congress are struggling with how to deliver on their promise of dismantling the ACA and creating a new health care policy. The foundation’s report did not address many of the concerns that Republicans have about the ACA, including health insurers citing financial losses in their ACA business as a reason for withdrawing from federal insurance exchanges around the country.

In the study, Vermont ranked first nationwide and Mississippi ranked 51st. A similar study by America’s Health Rankings issued in December ranked Hawaii first nationwide (Vermont came in fifth) and Mississippi dead last.

If North Carolina wanted to best Vermont, it would have to insure 832,580 more people and have to have 63,239 fewer emergency department visits by Medicare patients.

Still, North Carolina’s uninsured rate dropped from about 23 percent to about 16 percent.

Overall, North Carolina slipped in one general category and improved in 12. The decline was in death rates among Medicare patients hospitalized for a heart attack, heart failure, pneumonia or stroke. That rate increased from 13.7 percent in 2013 to 14.9 percent in 2015.

Thomas Ricketts, a senior policy fellow at the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill, said the purpose of state health rankings is to stimulate policy changes. But Ricketts noted that the rankings are relative to other states and could be misunderstood.

“You could be getting better but you could be falling in the rankings because more states are getting better faster,” Ricketts said.

The state’s best showing in the rankings included an increase in the number of children getting vaccines, a reduction of hospital readmissions, and a reduction in Medicare patients getting prescribed unsafe drugs.